Заболевания аорты у беременных

DOI: https://doi.org/10.29296/25877305-2024-04-03
Номер журнала: 
4
Год издания: 
2024

Г.Г. Тарадин(1), кандидат медицинских наук,
Е.В. Картамышева(2),
И.В. Ракитская(1), кандидат медицинских наук
1-Донецкий государственный медицинский университет
им. М. Горького Минздрава России
2-Городская больница №1, Горловка
E-mail: taradin@inbox.ru

Аортопатия у беременных обусловлена генетически определенной дисплазией соединительной ткани (синдромы Марфана, Элерса–Данло, Лойес–Дитца и др.). Самым тяжелым осложнением является аневризма аорты и ее расслоение с вероятностью фатального исхода. Ключевой фактор предотвращения этого осложнения – частая повторная визуализация (как метод выбора – ультразвуковая диагностика) и междисциплинарное взаимодействие, планирование и координация дородового периода, ведения родов и послеродового ухода.
Ключевые слова: 
акушерство и гинекология
беременные
аорта
аортопатии
дисплазия соединительной ткани
тактика ведения.
Для цитирования
Тарадин Г.Г., Картамышева Е.В., Ракитская И.В. Заболевания аорты у беременных . Врач, 2024; (4): 18-23 https://doi.org/10.29296/25877305-2024-04-03

Список литературы: 
  1. Marx N., Federici M., Schütt K. et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes: Developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). Eur Heart J. 2023; 44 (39): 4043–140. DOI: 10.1093/eurheartj/ehad192
  2. Huisman C., Zwart J., Roos-Hesselink J. et al. Incidence and predictors of maternal cardiovascular mortality and severe morbidity in the Netherlands: a prospective cohort study. PLoS One. 2013; 8 (2): e56494. DOI: 10.1371/journal.pone.0056494
  3. Lewis G. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011; 118: 1–203. DOI: 10.1111/j.1471-0528.2010.02847.x
  4. Carlson S., Schulz J., Ramu Bh. et al. Peripartum Cardiomyopathy: Risks Diagnosis and Management. J Multidiscip Healthc. 2023; 16: 1249–58. DOI: 10.2147/JMDH.S372747
  5. Ziccardi M., Siddique M. Peripartum Cardiomyopathy. StatPearls Publishing, 2023. URL: https://www.ncbi.nlm.nih.gov/books/NBK482185/
  6. Krexi D., Sheppard M. Cardiovascular causes of maternal sudden death. Sudden arrhythmic death syndrome is leading cause in UK. Eur J Obstet Gynecol Reprod Biol. 2017; 212: 155–9. DOI: 10.1016/j.ejogrb.2017.03.006
  7. Braund S., Leviel J., Morau E. et al. Maternal sudden death: A nationwide retrospective study. ENCMM study group. BJOG. 2023; 130 (3): 257–63. DOI: 10.1111/1471-0528.17294
  8. Matsushita T., Arakaki T., Sekizawa A. et al. Pregnancy-related maternal deaths due to cardiovascular diseases in Japan from 2010 to 2019: an analysis of maternal death exploratory committee data. J Matern Fetal Neonatal Med. 2023; 36 (1): 2175207. DOI: 10.1080/14767058.2023.2175207
  9. Nasiell J., Lindqvist P. Aortic dissection in pregnancy: the incidence of a life-threatening disease. Eur J Obstet Gynecol Reprod Biol. 2010; 149 (1): 120–1. DOI: 10.1016/j.ejogrb.2009.10.029
  10. Sawlani N., Shroff A., Vidovich M. Aortic dissection and mortality associated with pregnancy in the United States. JACC. 2015; 65 (15): 1600–1. DOI: 10.1016/j.jacc.2014.12.066
  11. Gelpi G., Pettinari M., Lemma M. et al. Should pregnancy be considered a risk factor for aortic dissection? Two cases of acute aortic dissection following cesarean section in non-Marfan nor bicuspid aortic valve patients. J Cardiovasc Surg (Torino). 2008; 49 (3): 389–91.
  12. Wanga S., Silversides C., Dore A. et al. Pregnancy and Thoracic Aortic Disease: Managing the Risks. Can J Cardiol. 2016; 32 (1): 78–85. DOI: 10.1016/j.cjca.2015.09.003
  13. Bowater S., Thorne S. Management of pregnancy in women with acquired and congenital heart disease. Postgrad Med J. 2010; 86 (1012): 100–5. DOI: 10.1136/pgmj.2008.078030
  14. Karamermer Y., Roos-Hesselink J. Pregnancy and adult congenital heart disease. Expert Rev Cardiovasc Ther. 2007; 5 (5): 859–69. DOI: 10.1586/14779072.5.5.859
  15. Braverman A., Mittauer E., Harris K. et al. Clinical Features and Outcomes of Pregnancy-Related Acute Aortic Dissection. JAMA Cardiol. 2021; 6 (1): 58–66. DOI: 10.1001/jamacardio.2020.4876
  16. Kamel H., Roman M., Pitcher A. et al. Pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis. Circulation. 2016; 134 (7): 527–33. DOI: 10.1161/CIRCULATIONAHA.116.021594
  17. Kim S., Wolfe D., Taub C. Cardiovascular outcomes of pregnancy in Marfan's syndrome patients: A literature review. Congenit Heart Dis. 2018; 13 (2): 203–9. DOI: 10.1111/chd.12546
  18. Yuan S. Aortic dissection during pregnancy: a difficult clinical scenario. Clin Cardiol. 2013; 36 (10): 576–84. DOI: 10.1002/clc.22165
  19. Делягин В.М. Развитие и строение клапанного аппарата сердца с позиции клинициста. Эффективная фармакотерапия. 2022; 18 (50): 16–27 [Delyagin V.M. Development and Structure of the Heart Valve Apparatus from the Position of a Clinicist. Effective pharmacotherapy. 2022; 18 (50): 16–27 (in Russ.)]. DOI: 10.33978/2307-3586-2022-18-50-16-26
  20. Делягин В.М., Аксенова Н.С., Докторова Н.М. Двустворчатый клапана аорты как показатель дисплазии соединительной ткани. Медицинский совет. 2018; 11: 181–4 [Delyagin W.M., Aksyenova N.S., Doktorova N.M. Bicuspid aortic valve as the mark of connective tissue disorders. Medical Council. 2018; 11: 181–4 (in Russ.)]. DOI: 10.21518/2079-701X-2018-11-181-184
  21. Zentner D., James P., Bannon P. et al. Familial aortopathies - state of the art review. Heart Lung Circ. 2020; 29 (4): 607–18. DOI: 10.1016/j.hlc.2019.12.010
  22. Ostberg N., Zafar M., Ziganshin B. et al. The genetics of thoracic aortic aneurysms and dissection: a clinical perspective. Biomolecules. 2020; 10 (2): E182. DOI: 10.3390/biom10020182
  23. Weinsaft J., Devereux R., Preiss L. et al. GENTAC Registry Investigators. Aortic dissection in patients with genetically mediated aneurysms: incidence and predictors in the GenTAC registry. J Am Coll Cardiol. 2016; 67 (23): 2744–54. DOI: 10.1016/j.jacc.2016.03.570
  24. Papagiannis J. Sudden death due to aortic pathology. Cardiol Young. 2017; 27 (1): 36–42. DOI: 10.1017/S1047951116002213
  25. Baas A., Spiering W., Moll F. et al. Six uneventful pregnancy outcomes in an extended vascular Ehlers-Danlos syndrome family. Am J Med Genet A. 2017; 173 (2): 519–23. DOI: 10.1002/ajmg.a.38033
  26. McCarrick G., Black J., Bowdin S. et al. Loeys-Dietz syndrome: a primer for diagnosis and management. Genetics in Medicine. 2014; 16 (8): 576–87. DOI: 10.1038/gim.2014.11
  27. Erbel R., Aboyans V., Boileau C. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014; 35 (41): 2873–926. DOI: 10.1093/eurheartj/ehu281
  28. Loeys B., Chen J., Neptune E. et al. A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2. Nat Genet. 2005; 37: 275–81. DOI: 10.1038/ng1511
  29. Frise C., Pitcher A., Mackillop L. Loeys-Dietz syndrome and pregnancy: the first ten years. Int J Cardiol. 2017; 226: 21–5. DOI: 10.1016/j.ijcard.2016.10.024
  30. Fedak P., de Sa M.P., Verma S. et al. Vascular matrix remodeling in patients with bicuspid aortic valve malformations: implications for aortic dilatation. J Thorac Cardiovasc Surg. 2003; 126 (3): 797–806. DOI: 10.1016/s0022-5223(03)00398-2
  31. Immer F., Bansi A., Immer-Bansi A. et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg. 2003; 76 (1): 309–14. DOI: 10.1016/s0003-4975(03)00169-3
  32. Regitz-Zagrosek V., Blomstrom Lundqvist C., Borghi C. et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the taskforce on the management of cardiovascular disease during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39 (34): 3165–241. DOI: 0.1093/eurheartj/ehy340
  33. Mokrzycki K., Biskupski A., Kuligowska E. Thoracic aorta aneurysm successfully operated on during pregnancy. Kardiochir Torakochirurgia Pol. 2014; 11 (3): 321–3. DOI: 10.5114/kitp.2014.45684
  34. Бакалов С.А., Бунин Ю.А., Бухонкина Ю.М. и др. Диагностика и лечение сердечно-сосудистых заболеваний при беременности. Кардиоваскулярная терапия и профилактика. 2010; 9 (6): 19–66 [Bakalov S.A., Bunin Y.A., Buhonkina Y.M. et al. Diagnostics and treatment of cardiovascular diseases in pregnancy. Cardiovascular therapy and prevention. 2010; 9 (6): 19-66 (in Russ.)].